Carotid Artery Stenting: Procedure, Recovery, and Risks

Carotid arteries are the two large blood vessels positioned on the sides of your neck that supply oxygenated blood to your brain, neck, and face. The usual topic that arises under the discussion of the Carotid arteries is Carotid artery disease, which causes almost 10-20% of strokes. Carotid stenting is a minimally invasive, non-surgical procedure wherein the clogged carotid arteries are opened by dilating them with a balloon (angioplasty) and inserting a metal scaffold to keep them open (stenting).

Is Carotid Artery A Serious Condition?

Similar to the blood vessels of the heart (coronary arteries), which get clogged by fat and cholesterol deposits (atherosclerosis), carotid arteries can also get blocked, which could lead to a stroke or brain attack, which is regularly known as carotid disease. While one cannot experience any external symptoms of carotid disease, doctors can identify this condition by checking for a whooshing sound in the neck with a stethoscope. The first sign of the disease will be a TIA (a transient ischemic attack).

As a result of this disease, initially, the vessels start to narrow, reducing the blood flow that eventually builds up plaque, causing blood clot blockage that ultimately leads to fatal strokes. One of the ways through which doctors treat carotid artery disease is through Carotid Stenting.

When Should I Opt For A Carotid Stenting Procedure?

Carotid stenting and angioplasty may be appropriate stroke treatment or stroke prevention options if:

• Your carotid artery is blocked by 70% or more, particularly after experiencing a stroke or related symptoms.
• You had a narrowing of the carotid artery following radiation for neck tumors.
• You’ve already had a carotid endarterectomy and are experiencing new narrowing after surgery (restenosis).

How Do You Prepare

Good preparation helps make carotid artery stenting safer and more effective. Your doctor will guide you through each step before the procedure.

• Take prescribed medicines: Your doctor may ask you to take aspirin and another blood-thinning medicine a few days before the procedure. These medicines help prevent blood clots. Do not skip them unless your doctor tells you to stop.
• Share your medical history: Tell your doctor about all health problems you have and the medicines you take. This includes diabetes drugs, pain relievers, and blood thinners.
• Undergo imaging tests: You may need tests like an ultrasound, CT scan, or MRI. These tests help the doctor clearly see the carotid artery and blood flow to the brain.
• Follow food and drink rules: Your doctor will tell you when to stop eating and drinking before the procedure. Follow these instructions carefully.
• Adjust current medications: You may need to stop or change some medicines before the procedure. Always follow your doctor’s advice.
• Take medicines with small sips of water: If your doctor allows certain medicines, take them with only a little water on the day of the procedure.
• Plan for hospital stay and travel: You may need to stay in the hospital overnight. Arrange for someone to take you home, as you will not be able to drive after the procedure.

Proper preparation reduces risks and helps ensure a smooth recovery after carotid artery stenting.

How Exactly Does The Procedure Happen?

In this procedure, a specially designed guidewire with a filter is positioned beyond the narrowed or blocked section of the carotid artery. After securing the filter, a small balloon catheter is advanced to the blockage site. When the balloon is inflated, it presses the fatty plaque or obstruction against the artery walls, expanding the vessel’s diameter to improve blood flow. Then, the balloon is removed, and a tiny tube called a stent is placed inside the artery to widen the opening to support the artery wall.

Once the stent is in position, an angiogram is carried out to verify that it has fully expanded and the narrowing or blockage has been resolved. In many cases, a second balloon catheter is used to fully expand the stent. The stent remains in place permanently, serving as a scaffold to keep the artery open, and over the following weeks, the artery naturally heals around it.

Usually, carotid stents are used along with a device called the embolic protection device (EPD). The EPD, resembling an umbrella or windsock, features a small basket designed to capture plaque particles that may become dislodged during the stenting process. By trapping these particles, it stops them from reaching the brain through the bloodstream, thereby lowering the risk of blood clots or strokes.

What Should I Expect After Completion Of The Procedure?

After the access sheath is removed, you will be required to lie flat without bending your legs to prevent bleeding. Afterward, you may be given medication to ease discomfort, and your doctor will decide how long you need to remain lying flat, typically between two and six hours.

Expect to stay in the hospital overnight after the procedure, during which your doctor will assess your condition. They will then perform a neurological exam and tests like a carotid ultrasound to assess the outcome and review the findings with you and your family.

Before you go home, you will be given instructions about your medications, a balanced diet, activity, and follow-ups. Your doctor will prescribe aspirin and clopidogrel to take for six months after the procedure. These medications work to stop blood clots from developing where the stent has been inserted. Follow your doctor’s instructions about medication timings. Always consult your doctor before stopping any of these medications.

After the procedure, you will need to take it easy for a few days. You can climb stairs, but use a slower pace. Do not strain during bowel movements. Gradually resume your regular activities by the end of the week until you return to your normal routine.

What Are The Risks I Should Be Aware Of Before Undergoing Carotid Stenting?

Like any surgical procedure, carotid angioplasty and stenting carry potential risks. Some of the complications include:

• Blood Clots: Stents can develop blood clots weeks or months after placement, increasing the risk of stroke. To minimize this risk, it is essential to take prescribed medications such as aspirin and clopidogrel as directed.
• Bleeding: The insertion site in the leg may experience bleeding, typically resulting in minor bruising. However, in rare cases, severe bleeding may occur, requiring a blood transfusion or additional medical intervention.
• Artery Narrowing (Restenosis): One of the main concerns after angioplasty is the possibility of the carotid artery narrowing again within months. To reduce this risk, drug-coated stents and post-procedure medications are used.
• Stroke or Transient Ischemic Attack (TIA): There is a risk of stroke during the procedure due to blood clots forming on catheters or dislodged plaque traveling to the brain. To lower this risk, blood thinners are administered during the procedure.

While complications are possible, proper precautions and medications help reduce these risks.

Can the Carotid Stenting Procedure Completely Cure Carotid Disease?

For most patients, carotid angioplasty and stenting improve blood flow to the brain and lower the risk of stroke. However, while the procedure opens the blocked artery, it does not cure carotid artery disease. It is important to continue managing risk factors through lifestyle changes to prevent the disease from progressing or recurring.

To achieve the best results, you should commit to a healthy lifestyle that includes quitting smoking, taking medications as prescribed, monitoring and recording your blood pressure, following a heart-healthy diet, managing high blood pressure, cholesterol, and diabetes, and attending regular follow-ups as advised by your doctor.

How to Prevent Conditions Requiring Carotid Stenting

You can lower the risk of carotid artery disease by making healthy lifestyle choices and managing medical conditions early. These steps help keep blood vessels clear and reduce the chance of needing carotid stenting.

• Eat heart-friendly foods: Choose fruits, vegetables, whole grains, lean meats, and healthy fats. Cut down on salty foods, fried items, processed snacks, and foods high in unhealthy fats. A healthy diet supports good cholesterol and blood pressure levels.
• Stay physically active: Aim for at least 30 minutes of exercise on most days of the week. Activities like walking, cycling, or swimming improve blood flow and keep the heart and arteries healthy.
• Keep blood pressure under control: Check your blood pressure regularly. Reduce salt intake, manage stress, stay active, and take medicines as advised by your doctor.
• Manage cholesterol levels: Limit foods high in saturated and trans fats. Follow a healthy eating plan and take prescribed medicines if needed to keep cholesterol in a safe range.
• Stop smoking: Smoking damages blood vessels and speeds up plaque buildup. Quitting smoking greatly lowers the risk of artery blockage and heart problems.
• Control blood sugar levels: If you have diabetes, manage it with proper diet, exercise, regular monitoring, and medicines as prescribed.
• Maintain a healthy body weight: Keeping your weight in a healthy range reduces stress on the heart and lowers the risk of artery disease.
• Go for regular health check-ups: Routine doctor visits help detect problems early and allow timely treatment to prevent serious artery conditions.

Frequently Asked Questions